Colen Publishing
www.colenpublishing.com ©™
Colen Publishing Colen Publishing, L.L.C. PO Box 36536 Grosse Pointe Woods, MI 48236 Author and Editor: Chaim B. Colen, M.D., Ph.D. Editorial Assistant: Roxanne E. Colen, PA-C COPYRIG PYRIGHT HT© 2008 2008 by Colen Publishing, Publishing, L.L.C. L.L.C. This book, including all all parts thereof, is legally protected by copyright. Any use, exploitation, exploitation, or comm commercialization ercialization outside the narrow limits set by copyright legislation without the author’s consent if illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage. Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made made in the text. Therefore, the appearance appearance of a name without without designation as proprietary is not to to be construed construed as a representati representation on by the publisher publisher that it it is is in the the public domain. Permissions may be sought directly from Colen Publishing, L.L.C. by writing to the above address. Printed in China Colen Flash-Review: Neurosurgery, 2nd Edition ISBN Volume Volume 1: 1-935345-01-X Volume Volume 2: 1-935345-02-8 2 Volume Volume Set: 1-935345-00-1 Note: Knowledge Knowledge in medicine medicine is is constantly changing. The author author has consulted consulted sources believed to be reliable in in the effort effort to provide information information that that is complete complete and in accord with the standards standards at the the time of publication. Howe However, ver, in view of the possibili possibility ty of human human error by the author in preparation of this this work, warrants warrants that the the information information contained herein is in every respect accurate and complete, and that the author is not responsible for any errors or omissions or for the results obtained from use of such information. The reader is advised to confirm the information contained herein with other sources. This is especially important in connection with new or infrequently used drugs. In such instances, the product information sheet included in the package with each drug should be reviewed.
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Preface •
The idea to undertake such a large Flashcard review spawned from watching my wife Roxanne study for her Physician Assistant Boards. Diligently every day she would create a set of 7-10 flashcards from her study material that she would take with her to work. Later on, when I was studying for my written Neurosurgery Board examination, I gleaned information from various texts and other study guides and wrote down the most relevant material on cards for quick review while at work. It was amazing how much time during the day would be available to review these cards. If there was a delay in a OR case, a long lunch-line, a traffic jam (especially the i94 on a Friday afternoon) or waiting for my wife at her OB/GYN appointment -these little cards were specially handy. Always ambitious in life, the thought of giving this study tool to the busy neurosurgery resident was captivating. My expectation is to enable the resident with a quick yet informative review of basic neuroscience principles. With positive encouragement from my fellow residents on the 1 st edition, I cautiously proceed here with updating information, adding new images, improved illustrations and clarification of neuroscience neuroscience concepts. May this endeavor serve to better our wonderful science inherited through the legacy of Harvey Cushing, Neurosurgery.
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The The Co Colen len Flas Flash h-Re -Review iew Author and Editor Chaim Chaim B. Cole Colen, n, M.D., M.D., Ph.D. Ph.D. Department of Neurological Surgery Wayne State University School of Medicine Detroit, Michigan Assistant Editor Roxanne E. Colen, M.S., PA-C Cole Colen n Publ Publis ishi hing, ng, LLC LLC Grosse Pointe, Michigan
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Acknowledgements I would like to give thanks to a great many wonderful persons whose efforts, although not inscribed in these cards, were instrumental in making this monumental task possible. One exceptional individual to whom I owe special thanks is my mother in-in-law, Colleen Johns, who babysat my daughter Emily and son Joshua for hours on end, while my wife and I toiled through hundreds of pages of various textbooks and journal articles, formatted questions, and drew computer illustrations. To my daughter Emily Rivka, who incessantly tugged at my pants trying to get my attention to the t he squirrel in our backyard ;and that big bright smile from my son Joshua that continuall continually y sent me optimism. optimism. To Mahmoud Mahmoud and Abhi who spent spent hours at my home assisting assisting with with typing, typing, researching and editing; Naomi whose positive attitude in life is exceptionally brightening and uplifted the group’s 2 am brainstorming sessions when I still had to wake up early to work the next day, all the pathologists, especially Doha, who assisted in taking photographs, Dr. William Kupsky, for allowing us access to his collection of unique neuropathology, and to all the medical students especially Kristyn, whose hard work is admirable. There are those whose names are not here but did assist in some way, thank you. I am forever indebted to my training program, program, the Wayne State University neurosurgery program, my Chairman Dr. Murali Murali Guthikonda, and Associate Associate Chairman Chairman Dr. Setti Setti S. Rengachary Rengachary whose whose moral support support over the last five years years has kept kept me on this educational drive. For this second edition, there were fellow residents that gave me input and new insight that has helped to improve this edition over the first. To my parents Joseph and Leila, educators of true dedicated quality, and to whom I owe my homeschooling education and self-motivation. Lastly to my wife Roxanne, whose patience with my ambitiousness knows no boundaries. ©™
Thank you All, Chaim
September 9, 2008
How to use this Flashcard review •
These cards are intended to cover most of the aspects of the Neurosurgery Board Examination. Examination. They are not a COMPLETE review and therefore they are not intended to replace textbooks. We would advise using these cards during the last couple of weeks before your board exam except for the pathology section which you should go through all year to better remember the photographs photographs in it (heavily encountered during the boards!). BOARD FAVORITE questions are of extreme importance and most likely to bump into during the boards, so make you sure you know how to answer them right.
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Good luck!
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Chaim Chaim B. Cole Colen, n, M.D., M.D., Ph.D. Ph.D. ©™
Faculty Reviewers Murali Murali Guthik Guthikond onda, a, MD Professor and Chairman Department of Neurological Surgery Wayne State University School of Medicine Detroit, Michigan Setti Setti Renga Rengach char ary, y, MD Associate Chairman Department of Neurological Surgery Wayne State University School of Medicine Detroit, Michigan William, J. Kupsky, MD Department of Neuropathology Wayne State University School of Medicine Detroit, Michigan
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Forward •
With ever increasing scope and complexity of knowledge base, the current day trainee or practitioner of neurosurgery finds it difficult to keep up with the explosion of neurosurgical information. This is compounded by a healthy growth in specialization in various branches of neurosurgery.
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Chaim has made an attempt attempt to make life life simpler simpler by incorporating incorporating small quanta of knowledge on flashcards accompanied by clear and simple illustrations. The user may review as few or as many cards as his/her time will allow. Although not meant to be substitutes for standard comprehensive texts and atlases, these cards help to refresh the information learned from the bedside, operating room and standard books. Each card represents a mini-examination with instant access to appropriate answers.
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This is a fun way to recall neurosurgical information especially before an upcoming test. Setti Setti S. Rengach Rengachary ary,, M.D. M.D. Department of Neurological Surgery
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Physician Contributing Authors Rivka Rivka R. Cole Colen, n, MD MD Department of Radiology The Massachusetts General Hospital Harvard Medical School Boston, Massachusetts Doha Itani, MD Department of Pathology WSU School of Medicine Detroit, Michigan
Mahm Mahmou oud d Raye Rayes, s, MD Department of Neurological Surgery WSU School of Medicine Erika Peterson, MD UT Southwestern, Department of Neurological Surgery Dallas, Texas
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Contributing Medical Students Darmafall, Kristyn Wayne State University School of Medicine Class of 2012
Galinato, Anthony Wayne State University School of Medicine Class of 2012
Larson, Sarah Wayne State University School of Medicine Class of 2012
Davis, Naomi Wayne State University School of Medicine Class of 2011
Gotlib, Dorothy Wayne State University School of Medicine Class of 2009
Martinez, Derek Wayne State University School of Medicine Class of 2011
Dub, Larissa Wayne State University School of Medicine Class of 2012
Kozma, Bonita Wayne State University School of Medicine Class of 2008
Matthew Smith Wayne State University School of Medicine Class of 2011
Faulkiner, Rodney Wayne State University School of Medicine Class of 2012
Lai, Christopher Wayne State University School of Medicine Class of 2010
Matto, Shereen Wayne State University School of Medicine Class of 2012 ©™
Contributing Undergraduates Undergraduates Jeffre Jeffrey y P. Kalla Kallas s Wayne State University Class of 2010 Abhin Abhinav av Krish Krishnan nan Wayne State University Class of 2010 Peter Paximadis Wayne State University Class of 2008
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Q? •
Neuropathology
This cerebellar specimen is consistent with: A. Lewy body B. Neuritic plaque C. Kuru plaque D. Hirano body
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A.
Neuropathology Neuropatholog Neuropathology y Section
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The correct answer is C, Kuru plaque.
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Pathology of variant of variant Creutzfeldt-Jakob disease – Kuru demonstrating a “kuru plaque” in cerebellum.
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Accumulation of prio of prionn protein PrP PrP in the form of amyloid plaques occurs in some forms of prion disease.
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Hirano bodi b odiees (rod-shaped eosin inclusions) are seen in Alzheimer’s in Alzheimer’s disease.
Kuruu Plaque Kur Plaque
PAS Liberski PP. Amyloid plaques in transmissible spongiform encephalopathies (prion diseases). Folia Neuropathol. 2004;42 Suppl B:109-19. Review.
Cerebellum: granular gr anular cell layer
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Q? •
Neuropathology
This brain specimen is most consistent with: A. Lewy body B. Neuritic plaque C. Kuru plaque D. Hirano body
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A.
Neuropathology
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The correct answer is D, Hirano body.
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Hirano bodi b odiees (rod-shaped eosin inclusions of mostly actin filaments) are seen in Alzheimer’s in Alzheimer’s disease.
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Accumulation of prio of prionn protein PrP PrP in the form of amyloid plaques occurs in the pathology of variant of variant Creutzfeldt reutzfeldt-Jakob disease – Kuru demonstrates “ kuru plaque plaques” s” in the cerebellum.
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Lewy bodie bod iess are seen in Parkinson’s disease and diffuse Lewy body disease. These are formed from αsynuclein.
BOARD FAVORITE!
Hirano Hira no body bod y
Section of hippocampus hipp ocampus
Kuljis RO: Modular corticocerebral pathology in Alzheimer's disease. In: Mangone CA, Allegri RF, Ariza, eds. Dementia: A Multidisciplinary Approach. 1997: 143-55.
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Q? •
Neuropathology
What is the most likely diagnosis seen in this fundoscopic examination? A. Drusen bodies B. Retinopathy of diabetes C. Retinal hemorrhage D. Pseudopapilledema
Used with permission from Handbook of Neurosurgery and Neurology in Pediatrics; By Chaim B. Colen, MD, PhD.
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A.
Neuropathology
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The correct answer is C, retinal hemorrhages.
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Shaken haken baby syndro syn drome me was described by Caffey as a clinical triad: subdural hematomas, subarachnoid hemorrhages, and retinal hemorrha hemorrh ages.
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"Shaken baby syndrome" (SBS) results in intracranial and intraocular hemorrhages with no evidence of external trauma. The cause of these injuries is vigorous shaking of an infant being held by the chest, shoulders, or extremities.
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Physicians are mandated to report cases of child abuse, elder abuse, sexual abuse, dom domestic estic vi violence, olence, and assau assaullt. Physi hysician cians s are are al also requi required to not notify the aut authori horitties if anyone has a specific plan to commit suicide or homicide.
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Druse rus en bodies bo dies aka “pseudopapilledema” are colloid or hyaline bodies lying beneath the retinal pigment epithelium. They may occur either secondary to changes in the choroid that affect the pigment epithelium or as an autosomal dominant disorder of the retinal pigment epithelium.
Martin HA, Woodson A, Christian CW, Helfaer MA, Raghupathi R, Huh JW. Shaken baby syndrome. Crit Care Nurs Clin North Am. 2006 Sep;18(3):279-86. Review.
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Q? •
Neuropathology
Which pairing is most accurate for the localization of medulloblastomas in the pediatric and adult population? A. Chil Children dren : Mi Midline dline,, Adul dults : Mi Midline dline B. Chil Children dren : Lat Lateral, Adul dults : Lat Lateral C. Chil Children dren : Lateral Lateral,, Adul dults : Mi Midline dline D. Chil Children dren : Mi Midline dline,, Adul dults : Lat Lateral
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A. •
Neuropathology
BOARD FAVORITE!
The correct answer is D, children : midline, adults: lateral
Homer-Wright rosette –( rosette –(pseudorosette pseudorosette ) radially radially arranged arranged nuclei surroun surrounding ding central central fibrillary material (red arrow); histopathological features of medulloblastoma.
MRI brain -contrast enhanced sagittal image showing the midline location of the tumor in a pediatric patient.
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Q? •
Neuropathology
Compared to pilocytic astrocytoma: A. This tumor has a better prognosis B. This tumor has a similar prognosis. C. This tumor has a worse prognosis D. Prognosis is irrelevant
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A.
Neuropathology
BOARD FAVORITE!
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The correct answer is C, this tumor has a worse prognosis..
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Gemistocytic astrocytoma is WHO WHO grade gr ade II and is distinctive in its appearance, having astrocytes with generous eosinophilic cytoplasm with a “stuffed “stuffed”” stellate appearance.
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Low-grade astro astrocyto cytomas mas with a significant fraction of gemistocytes progress more rapidly and typically carry a p53 mutation mutation.. Gemistocytic astrocytoma
PDGFR increase
Progenitor cell
Grade II astro
Secondary GBM
Grade III astro
Secondary GBM
P53 loss pRB loss, NK4α increase, PTEN, loss Krouwer HG, Davis RL, Silver P, Prados M. Gemistocytic astrocytomas: a reappraisal. J Neurosurg. 1991 Mar;74(3):399-406.
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Q? •
Neuropathology
This muscle specimen (Gomori stain) is consistent with which disorder? A. Myoclonic seizures B. Disuse atrophy C. Steroid atrophy D. Denervation atrophy
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A.
Neuropathology
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The correct answer is A, myoclonic seizures.
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Mitochondrial disorders (e.g. MELAS, MERRF) clinically are associated associated with with seizures and muscle biopsy shows ragged-red fibers fib ers and rimmed rim med vacuoles vacuoles .
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Type 1 fiber atrophyatrophy- think muscle disease! disease! -myotonic dystrophy and congenit congenital al myopat yopathy
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Type 2 muscle musc le atrophyatrop hy- think neurogenic or muscle disease! – denervation, disuse, myasthenia gravis, steroids and paraneoplastic syndrome (BOARD FAVORITE!)
RA GGED RED FIB ERS
BOARD FAVORITE!
RIMMED VA CUOL E
Fukuhara N, Tokiguchi S, Shirakawa K, Tsubaki T. Myoclonus epilepsy associated with ragged-red fibres (mitochondrial abnormalities ): disease entity or a syndrome? syndrome? Light-and electron-m electron-micr icroscopic oscopic studies studies of two cases cases and review review of literat literature. ure. J Neurol Sci. Sci. 1980 Jul;47(1):117-33. Jul;47(1):117-33.
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Q? •
Neuropathology
This peripheral nerve biopsy is consistent with: A. Myasthenia gravis B. Onion bulb formation C. Wallerian degeneration D. Neurofibroma
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A.
Neuropathology
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The correct answer is B, onion bulb formation.
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Onion bulb formation occurs after repeated cycles of demyelination and remyelination result in a thick layer of abnormal myelin around the peripheral axons. These changes cause what is referred to as an onion bulb appearance.
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May be seen in a few disorders: Charcot-Marie-Tooth (CMT) and Refsu Refsum’s m’s disease d isease (phytanic acid disorder).
ONION ONI ON BULBS BULB S
BOARD FAVORITE!
ONION ONIO N BULB (electro (elect ronn microscopy)
Bornemann A, Hansen FJ, Schmalbruch H: Nerve and muscle biopsy in a case of hereditary motor and sensory neuropathy type III with basal lamina onion bulbs. Neuropathol Appl Neurobiol 1996 Feb; 22(1): 77-81.
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Q? •
Neuropathology
Symptoms of a patient with this diagnosis might be alleviated with which of the following drugs: A. Retroviral drug B. Anticholinesterase inhibitor C. Beta-interferon D. Trimethoprimsulfamethoxazole
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A.
Neuropathology
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The correct answer is A, anticholinesterase inhibitor.
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Microscopy shows an amyloid plaque and neurofibrillary tangles that would be consistent with the diagnosis of Alzheimer’s Alzheimer’s disea dis ease. se.
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Donepezil is a synthetic noncovalent reversible inhibitor of acetylcholineste cetylchol inesterase rase (AChE) for the treatment of mild to moderate dementia associated with Alzheimer's disease.
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Other drugs include galantamine and and ri rivasti vastigm gmiine. ne.
Amyloid plaque plaque
Neurofibrill rofibrilla ary tangle tangle
Kuljis Kuljis RO: Modular Modular corticocerebral corticocerebral pathology in in Alzheimer's disease. disease. In: Mangone CA, CA, Allegri Allegri RF, Ari Ariza, za, eds. Dementi Dementia: a: A Multidi ultidiscipl sciplinary inary Approach. 1997: 14 143355
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Q? •
Neuropathology
This brain specimen is most consistent with: A. Alzheimer’s disease B. Parkinson’s disease C. Pick’s disease D. Wilson’s disease
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A.
Neuropathology
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The correct answer is B, Parkinson’s disease.
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Microscopy shows melanophages and neuronal neuronal cell loss lo ss in the substantia nigra pars compacta.
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Lewy bodie bod iess are also seen. These are formed from αsynuclein.
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Pick bodie bodi es are seen in Pick’s disease using silver stain. NEURONA L L OSS
BOARD FAVORITE!
L EWY B ODY
Hodaie M, Neimat JS, Lozano AM. The dopaminergic nigrostriatal system and Parkinson's disease: molecular events in development, disease, and cell death, and new therapeutic therapeutic strategies. strategies. Neurosurgery. Neurosurgery. 2007 Jan;60(1):17-28; Jan;60(1):17-28; discussion 28-30.
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Q? •
Neuropathology
This neonatal brain specimen is consistent with which hemorrhage grade? A. Grade I B. Grade II C. Grade III D. Grade IV
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A.
Neuropathology
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The correct answer is C, grade III.
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This gross specimen demonstrates germinal matrix hemorr hemorrhag hage e (G (GMH) and intraventr intraventriicular hemorr hemorrhage hage (IVH) and hydrocephalus which are the most common and most important neurologic injuries in preterm neonates.
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Premature infants lack the ability to autoregulate the cerebral blood pressure. Fluctuations in cerebral blood pressure and flow can rupture the primitive germinal matrix vessels or lead to infarction of the metabolically active germinal matrix. Neurologic sequelae, include cerebral palsy, mental retardation, and seizures. Grading System Grade Grade 1 - confin confined ed GMH GMH Grade 2 - IVH without without hydroc hydrocephalu ephalus. s. Grade 3 - IVH with associated associated hydrocephalu hydrocephalus s Grade 4 - Intraparenchy Intraparenchymal mal hemorrhage hemorrhage
BOARD FAVORITE!
IVH and hydrocephalus
GMH
GRADE 3
Levy ML, Masri LS, McComb JG: Outcome for preterm infants with germinal matrix hemorrhage and progressive hydrocephalus. Neurosurgery 1997 Nov; 41(5): 1111-7; discussion 1117-8.
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Q? •
Neuropathology
This pathology is most likely due to: A. Vitamin A toxicity B. Cyanocobalamine deficiency C. Thiamine deficiency D. Vitamin B6 deficiency E. Alcohol intake
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A.
Neuropathology
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The correct answer is C, thiamine deficiency.
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Thiamine deficiency is seen in chronic malnourished alcoholics. Note the old infarction that has occurred in the mamillary bodies.
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Wernicke-Korsakoff’s syndrome – subacute amnesia seen in damage to the mamillary bodies and may be caused by thiamine deficiency and may be reversible with the administration of thiamine.
BOARD FAVORITE!
Old infarction
©™ Torvik A. Topographic distribution and severity of brain lesions in Wernicke's encephalopathy. Clin Neuropathol. 1987 Jan-Feb;6.
Q? •
Neuropathology
This brain specimen is most consistent with which disease? A. Wilson’s son’s (hepatol (hepatolen entticular degeneration) B. Alzheimer’s C. Pick’s D. Parkinson’s E. Huntington’s
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A.
Neuropathology
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The correct answer is A, Wilson's disease (hepatol (hepatolenticul enticular ar degen degenerati eration on). ).
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Wilson’s disease disease is caused by accumulation of copper in the brain with decreased decreased serum s erum coppe copp er and cerul cerulopl oplaasmin and increased urine uri ne coppe copp er . Kayser-Fleischer Kayser-Fleischer rings rin gs form around the iris.
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Microscopy demonstrates Alzhe demonstrates Alzheimer imer type t ype 2 astrocytes which have a large clear vesicular nuclei and prominent nucleoli. Proliferation of large protoplasmic astrocytes such as Opalski Opalski cells may be seen.
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Research suggests that these reactive astrocytes may be involved in the process of copper detoxification in WD.
BOARD FAVORITE!
Bertrand E, Lewandowska Lewandowska E, Szpak GM, Hoogenraad Hoogenraad T, Blaauwge Blaauwgers rs HG, HG, Czlonkowska Czlonkowska A, Dymecki Dymecki J. Neuropathol Neuropathological ogical analysis of pathologi pathological cal forms of astroglia in Wilson's disease. Folia Neuropathol. 2001;39(2):73-9.
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Q? •
Neuropathology
This muscle biopsy specimen is consistent with: A. Congenital myopathy B. Myotonic dystrophy C. Steroid myopathy D. Mitochon ochondri drial al myopathy yopathy 1 Note: Type 1 fibers labeled (1 (1).
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A.
Neuropathology
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The correct answer is C, steroid myopathy.
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Steroi Steroidd myopathy m yopathy is i s characteriz characterizeed by type 2 myofiber myof iber atrop atrophy! hy!
BOARD FAVORITE!
TYPE 2 ATROPHY •
Type 1 fiber atrophyatrophy- think muscle disease! disease! -myotonic dystrophy and congenit congenital al myopat yopathy
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Type 2 muscle musc le atrophyatroph y- think neurogenic or muscle disease! –denervation, disuse, myasthenia gravis, steroids and paraneoplast paraneoplastiic syndrom syndrome e (BOARD FAVORITE)
STEROID MYOPA MYOPA THY
©™ Griggs RC, Mendell JR, Miller RG: Congenital myopathies. In: Evaluation and Treatment of Myopathies. Philadelphia: FA Davis Co; 1995: 211-46.
Q? •
Neuropathology
This gross brain specimen is most consistent with: A. Adrenoleukodystrophy B. Multiple sclerosis C. Mitochon ochondri drial al myopathy yopathy D. Canavan’s disease
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A.
Neuropathology
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The correct answer is B, multiple sclerosis.
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Multipl Multi plee sclerosi scl erosiss (MS (MS)) is an idiopathic (autoimmune?) inflammatory demyelinating disease of the CNS. Animal model experi experimenta mentall all allergic ergic encephalom encephalomyeliti yelitiss demonstrated by autoimmunity to myelin basic basi c pro p rotein teins. s. (BOARD FAVOR FAVORIT ITE) E)
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Episodes of de/remyelination result in a chronic burned-out plaque with relative preservation of axons and gliosis (recently axon transection has been reported in acute exacerbations).
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Incidence is higher in Caucasians. Femaleto-male ratio is 2:1.
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Classic presentation -optic neuritis, transverse myelitis, internuclear ophthalmoplegia, paresthesias
BOARD FAVORITE!
Periventricular location
Chron hronic ic pla pl aques
Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG: Multiple sclerosis. N Engl J Med 2000 Sep 28; 343(13): 938-52.
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Q? •
Neuropathology
The gross spinal cord specimen (A) is most consistent with: A. Adrenoleukodystrophy B. Multiple sclerosis C. Amyotrophic lateral sclerosis D. Neurofibromatosis
A
B ©™
156
A.
Neuropathology
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The correct answer is C, amyotrophic lateral sclerosis. sclerosis.
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Amyotrophic Amyotrop hic lateral lateral sclerosis progressive loss of upper and lower motor neurons.
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Pathology: Pathology : progressive loss of anterior horn cells leads to atrophy of ve v entral nerve fibers and of skeletal muscles; progressive loss of primary motor neurons in motor cortex leads to degeneration of cort corticosp icospinal/ inal/ cort corticob icobulba ulbarr trac tracts. ts.
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Adrenoleukodystr Adrenoleukodystrophy ophy (ALD)(ALD)leukodystrophy is an x-linked recessive disease due to deficiency in peroxisomal lipid oxidation.
BOARD FAVORITE!
Ventral nerve root atrophy
A
Normal ventral roots
B
Gartner J, Braun A, Holzinger A , et al: Clinical and genetic aspects of X-linked adrenoleukodystrophy. Neuropediatrics 1998 Feb; 29(1): 3-13.
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Q? •
Neuropathology
This gross brain specimen shows atrophy that is consistent with: A. Multiple sclerosis B. Pick’s disease C. Alzheimer’s disease D. Acute cerebral infarction
©™ 157
A.
Neuropathology
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The correct answer is Alzheimer’s disease.
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Alzheimer’s Alzheimer’s disea dis ease se is the most common dementing illness in adults, characterized by progressive dementia over several years. There is increased frequency with increasing age and in familial cases, usually earlier onset.
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Note the diffuse diffuse brain brain atroph atrophyy of Alzheimer's Alzheimer's disea dis ease se,, unlike Pick’s disease which has mostly frontal lobe atrop atrophy. hy.
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Risk is i s increa in creased sed in Down’s synd sy ndro rome me (BOARD FAVORI FAVORITE TE). ).
BOARD FAVORITE!
Frontal Atrophy Atro phy
Tempor Te mporal al Atrophy ©™ Kuljis RO: Modular corticocerebral pathology in Alzheimer's disease. In: Mangone CA, Allegri RF, RF, Ariza, eds. Dementia: Dementia: A Multidi ultidiscipl sciplinary inary Approach. 1997: 143-55.
Q? •
Neuropathology
The pathology seen here is most likely due to: A. Cerebellar astrocytoma B. Alcoholism C. Trauma D. Ruptured aneurysm E. Arteriovenous malformation
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A.
Neuropathology
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The correct answer is….
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To obtain ob tain the answ answeer to this t his questio q uestionn and and to to view over 400 400 more comprehe comp rehensi nsive ve pathology questions please please purcha purch ase the full product here here!!
BOARD FAVORITE!
©™ Bolla L, Palmer RM: Paraneoplastic cerebellar degeneration. Case report and literature review. Arch Intern Med 1997 Jun 9; 157(11): 1258-62.
